Job Application: CNA with QMAP

APPLICATION FOR EMPLOYMENT for:
Sisters of St Francis of Colorado Springs, Inc.,7665 Assisi Heights Colorado Springs, CO 80919
and its Ministries: St Francis Nursing Center, Inc., (d.b.a. Mount Saint Francis Nursing Center), Franciscan Community Counseling, Inc., and Franciscan Retreat Center, Inc. All Ministries are Equal Opportunity Employers. We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, genetic information or any other status protected by law or regulation. It is our intention that all qualified applicants are given equal opportunity and that selection decisions be based on job related factors.
Answer each question fully and accurately. No action can be taken on this application until you have answered all questions.

What skills or additional training do you have that relate to the job for which you are applying?

What machines or equipment can you operate that relate to the job for which you are applying?

Work History

List work history by most recent employment first. Account for all periods of time including military service and any periods of unemployment. Note:A job offer may be contingent upon acceptable references from current and former employers.

Name of Employer

Address

City,State,Zip Code

Supervisor(s)

Telephone

Job Title

Duties

Dates of Employment

From:

To:

Pay Rate $

Reason for Leaving

Name of Employer

Address

City, State, Zip Code

Supervisor(s)

Telephone

Job Title

Duties

Dates of Employment

From:

To:

Pay Rate $

Reason for Leaving

Name of Employer

Address

City,State, Zip Code

Supervisor(s)

Telephone

Job Title

Duties

Dates of Employment

From:

To:

Pay Rate $

Reason for Leaving

Name of Employer

Address

City,State,Zip Code

Supervisor(s)

Telephone

Job Title

Duties

Dates of Employment

From:

To:

Pay Rate $

Reason for Leaving

References

Have you worked or attended school under any other names?

Yes
No

If yes,give names

Are you presently employed?

Yes
No

If yes,whom do you suggest we contact?

Have you ever been fired from a job or asked to resign?

Yes
No

If yes,please explain

Give three references, not relatives or former employers

Reference #1

Address

Phone

Reference #2

Address

Phone

Reference #3

Address

Phone

Have you seen or reviewed a job description?

Yes
No

Do you understand the job requirements?

Yes
No

Can you perform the job requirements with or without reasonable accommodation?

Yes
No

Please let us know how you heard about this position?

A friend, family member
Professional associate
Through a job fair or article
Newspaper ad

Please enter Name or Source

OPTIONAL Upload your Resume

PLEASE READ EACH STATEMENT CAREFULLY BEFORE SUBMITTING APPLICATION.
I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date. I authorize the investigation of any or all statements contained in this application. I also authorize, whether listed or not, any person, school, current employer, past employers, and organizations to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements. I hereby consent to a pre- and/or post-employment drug screen as a condition of employment, if required. I understand that if I am extended an offer of employment it may be conditional upon my successfully passing a Tuberculin (PPD) skin test and a background screening.I UNDERSTAND THAT THIS APPLICATION, ANY VERBAL STATEMENTS BY MANAGEMENT OR SUBSEQUENT EMPLOYMENT, DO NOT CREATE AN EXPRESS OR IMPLIED CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. I UNDERSTAND EMPLOYMENT WITH A MOUNT ST FRANCIS MINISTRY IS AT-WILL AND MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT REASON, AND WITH OR WITHOUT NOTICE.
I have read, understand, and by submitting my application, I consent to these statements.